Neuromyelitis optica (NMO), also known as neuromyelitis optica spectrum disorder (NMOSD) or Devic disease, is a rare autoimmune disease that affects the eyes and spinal cord. In the United States, approximately 4,000 people have been diagnosed with NMO. The disease occurs when the body's immune system mistakenly attacks healthy cells in the central nervous system, which includes the brain and spinal cord.
There are two types of NMO:
Monophasic NMO: Attacks happen over days or weeks.
Relapsing NMO: There are long periods between attacks, sometimes months or years. Symptoms may disappear but can return and worsen over time.
While men and women are equally likely to develop monophasic NMO, women are more prone to relapsing NMO. Children can also be affected by the disease.
The symptoms of NMO can be divided into two main categories:
Optic neuritis: Inflammation of the optic nerve, which carries information from the eye to the brain. Symptoms may include sudden eye pain, blurred vision, or even blindness, usually in one eye but sometimes in both.
Transverse myelitis: Inflammation of the spinal cord, causing problems with the arms and legs, such as pain, weakness, numbness, or paralysis. It can also lead to loss of bladder and bowel control, nausea, vomiting, hiccups, a stiff neck, or headaches.
In children with NMO, additional symptoms may include confusion, seizures, or falling into a coma.
NMO is often confused with multiple sclerosis (MS) because both conditions cause inflammation and mobility issues. However, research has shown that they are distinct diseases:
MS usually progresses more slowly over a longer period.
There is a blood test for NMO, but not for MS.
An MRI of the brain usually appears normal when first diagnosed with NMO, but not with MS.
NMO may cause nausea, vomiting, and hiccups, which are not common in MS.
The exact cause of NMO is unknown. It does not appear to be hereditary, but many people with NMO also have other autoimmune diseases, such as type 1 diabetes, rheumatoid arthritis, psoriasis, or vitiligo, or have family members with these conditions.
To diagnose NMO, your doctor will perform a physical examination and assess your thinking, vision, speech, strength, and reflexes. They may also order the following tests:
Blood tests to check for the presence of a specific antibody found in more than 70% of people with NMO.
Spinal fluid tests to check for inflammation.
MRI (magnetic resonance imaging) to create an image of your spinal cord and check for inflammation.
Optical coherence tomography (OCT) performed by an ophthalmologist to check for damage to the optic nerve.
While there is no cure for NMO, several treatments can help manage symptoms and prevent future attacks:
FDA-approved drugs: Eculizumab (Soliris), inebilizumab-cdon (Uplizna), and satralizumab-mwge (Enspryng) target the defective antibodies that trigger NMO.
Immunosuppressants: Your doctor may prescribe other drugs to suppress your immune system and prevent future attacks.
Steroids or corticosteroids: These medications help reduce inflammation and are usually administered intravenously (IV).
Plasma exchange (plasmapheresis): This procedure removes harmful antibodies from the blood using a machine that separates blood components, replaces the plasma with a substitute, and returns the new blood to your body.
If you experience any symptoms of NMO, such as sudden eye pain, vision problems, or weakness in your arms or legs, consult your doctor immediately. Early diagnosis and treatment can help manage the disease and improve your quality of life.
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